Address: 1701 Golf Rd. Rolling Meadows, IL 60008

Hours: Monday- Friday 8:30 AM -5:00 PM

Major Responsibilities:

• Management of the centralized referral process.
  •     1)Works in all aspects of centralized referral process, including processing referrals to members, physicians and specialists, under the direction of the supervisor, RNs and Medical Directors and per medical policies and criteria.
  •     2)Generates necessary correspondence or calls to members, physicians and office staff, managed care organizations or vendors requesting additional information.
  •     3)Communicates with appropriate staff and members regarding follow-up status of referrals.
  •     4)Works with PHO staff to file, prepare correspondence, data entry, system documentation and other medical management related activities.
  •     5)Initial order and renewal of DME referrals under supervision of case manager.
• Participate in education and utilization management activities.
  •     1)Works with case manager and UM specialist in the education of physician office staff on referral procedures, AHP policies and procedures and benefit plan limitations.
  •     2)Acts as a resource to customers and help resolve referral, claim and eligibility issues.
  •     3)Communication with AHP case manager and UM specialist supervisor, manager, director, other health care professionals, and various staff in a positive fashion in order to promote member satisfaction, quality services delivered and resolution of issues.
  •     4)Verify eligibility for members including problem resolution with Advocate MSO and various managed care organizations.
  •     5)Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations.

Education/Experience Required:

• • LPN, AA Degree or equivalent 3-4 years experience in a managed care organization, hospital or physician’s office • Medical record experience preferred and/or medical terminology

Knowledge, Skills & Abilities Required:

• • Good verbal and written communications skills • Excellent interpersonal communication skills • Ability to work as a team member • Good computer keyboard proficiency • Good organizational skills • Ability to handle difficult calls and maintain professional conduct • Willingness to be flexible with job responsibilities
• Licensure not mandatory

Physicial Requirements and Working Conditions:

• • Ability to work independently. • Local travel. • Ability to handle stress and high workload volumes. • Flexible with work assignments. • Ability to communicate denial of services to members and providers • Ability and willingness to be cross-trained in case management activities.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.